Aet515 Instructional Plan Part III

Critical Thinking in Dentistry| Slide 1
AET/515
Instructional Plan

Critical Thinking in the health professions
curriculum of Dentistry

Patricia Hammock

Needs Assessment
1. What is the learning problem or opportunity?
The need for critical thinking skills in the health professions education curriculum for dental students. Students learn subjects like
biochemistry and pharmacology in silos; no integration. However, licensure examinations are constructed in an integrative manner
and students will be expected to practice integrating medicine and dentistry after graduation.
2. What is currently available?
Discipline specific courses are taught by subject matter experts, who fail to address critical thinking and interrelatedness of the basic
and clinical sciences. Students are assessed via and must practice in an integrated manner taking medical conditions into
consideration when practicing dentistry.
3. What should be available?
Faculty should take a team approach to providing instruction in the dental curriculum incorporating critical thinking skills and
analytical reasoning. For example, a biochemistry instructor should team teach with a clinical pharmacologist to adequately prepare a
dental student to provide services to a patient with periodontal disease and high blood pressure.
4. Explain the gap analysis between what is available and what should be available.
During the last six years, the clock hours for critical thinking for dental freshmen has been cut from 32 to 0 clock hours. The Critical
Thinking component of dental education should be reinstated at the 32 clock hour level.
5. What is your recommended solution for filling the gap?
Develop a pilot assessment which measures critical thinking and integration of basic sciences and clinical knowledge. Restructure the
existing curriculum to incorporate the acquisition of critical thinking skills. Freshmen/Sophomores should be exposed to the varied
levels of critical thinking so the basic (biochemistry) and clinical (pharmacology) sciences are interrelated. Preclinical and critical
thinking faculty should work together to review basic dental curricular materials with a critical thinking lens. Require passage of pilot
assessment at 85% and above prior to student becoming eligible to sit for licensure examinations.

Instructional Goal

What should the learners be able to do after successfully completing this instructional
plan?

Apply components of critical thinking to all levels of
learning and successfully negotiate School of Dentistry
competency examinations and the National Board Dental
Examinations (NBDE) Parts I and II.


Performance-Based Objectives

Objective 1- Upon completion of instruction:
Freshman dental students will be enabled to define critical thinking and its components.
Sophomore dental students will be able to integrate pre-clinical instruction with critical thinking skills.
Junior students will learn how to learn to self-assess their critical thinking skills as related to clinical reasoning.
Senior students will, through self-assessment and peer review, improve critical thinking skills related to the clinical sciences.

Objective 2- Upon completion of instruction:

Freshman dental students will apply the levels of critical thinking to their coursework.
Sophomore dental students will be able to apply critical thinking skills to their pre-clinical laboratory work.
Junior dental students will learn how to self-assess their critical thinking skills as relates to the observation of dental patient care.
Senior dental students will synthesize prior knowledge and apply critical thinking skills to make appropriate decisions regarding patient
care.


Summative Assessment and Learning
Outcomes

Course Examinations Computer based multiple choice questions and clinical cases.
Self-Assessment Students assess their own knowledge of critical thinking and its components.
Peer Review Students evaluate each others level of understanding with faculty support.
Preceptor Review Student performance in the dental clinics will be guided by a preceptor/faculty.
Competency Examinations Computer based multiple choice and clinical cases.
NBDE Part I and NBDE Part II (licensure examinations) - computer based multiple choice and
clinical cases.

Learner Characteristics

Students at ABC Dental School come from across the United States and several foreign countries. 72 (9%) students are from the northeast; 584
(76%) are from the south; 64 (8%) are from the Midwest; 47 (6%) are from the west; and 5 (1%) are from foreign countries.

In terms of ethnic/racial make-up, the majority of students are Black, Non-Hispanic (670/87%). Other represented groups include White, Non-
Hispanic (26/3%), Asian/Pacific Islander (41/5%), Hispanic (33/4%), and American Indian/Alaskan Native (2/. 3%).
More females (446/58%) than males (326/42%) are enrolled.

The age range for students enrolled at ABC Dental School is 20 years old to 64 years old. The youngest group, 20-21 year olds, comprises 2%
(15) of the population, and the oldest group, 50-64 year olds, is less than 1% (2/.3%) of the population. The majority of enrolled students are
ages 22 to 29 years old (636/82%). The remaining distribution by age groups is 30-34 year olds (89/12%), 35-39 year olds (17/2%), and 40-49
year olds (13/2%).

Specific characteristics: prerequisite skills, learner attitudes or aptitudes
The vast majority of ABC Dental School students hold a bachelors degree from an accredited four-year institution and have an aptitude for
health professions education as evidenced by successful negotiation of the Medical College Admission Test MCAT or Dental Admission Test
DAT and admission into health professions school.

Learning styles: How your target audience processes information
ABC Dental School students are assessed at orientation regarding their personality type, learning style, study skills and health sciences reasoning
ability. The data suggests that instruction should be multi-modal, appealing to those students who learn best visually, through hearing and/or by
doing (kinesthetic). Instruction should employ didactic lecture, graphics, text and videos, CDs and YouTube demonstrations, hands-on laboratory
work and dental patient simulations. Kinesthetic learners will flourish in gross anatomy, the laboratory and through direct patient contact. The
2012 incoming dental class is overwhelmingly introverted, indicating that they focus their attention on the inner world of ideas and impressions.


Learner Characteristics
What are the implications to your instructional plan based on these
characteristics?

Because there is such a wide age range of learners enrolled in ABC Dental School (20 to 64),
the instruction would need to incorporate a variety of modalities. Feedback should be
continuous, timely and constructive. Instruction should employ mediums with which each
generation is familiar and provide opportunities for the learners to experience the instruction
via written text, videos, CDs, laboratory, observation and hands-on simulation, appealing to
all learning styles. More mature (older) students should be allowed to relate the learning to
their experiences and share that knowledge with their younger counterparts. Collaboration
can be sought through small group, case-based learning. Learners should be given the
opportunity to enhance their learning through self-study, social learning, and games, along
with classroom instruction.

Intended instructional setting

Classroom/didactic lecture; small group problem-based, student-centered learning; Simulation Centers; Laboratories; and Dental
Clinics. Freshmen are instructed via classroom / didactic lecture and small groups. Sophomores are instructed via laboratory,
classroom/ didactic lectures and small groups. Juniors are instructed via clinical observation with a preceptor. Seniors are instructed via
direct patient contact in the dental clinics with a faculty observer.

Intended application setting

Students will have direct patient contact through the dental clinics. Upon graduation, students will practice dentistry in a dental office
or clinic, conduct research on various aspects of dentistry or enter a general practice residency program where they will learn all
aspects of managing a successful dental practice.

Explanation of how the information about the learning context
will be used in developing the instructional plan.

Ultimately, all dental students will have direct patient contact. All instructional activities are geared toward producing competent dental
professionals who are capable of modeling best practices for the dental profession and offering patient-centered dental care. The
instruction will follow Dales Cone of Experience.
Learning Context


Delivery Modality:

Freshmen: The primary delivery modality for freshmen dental
students will be classroom/didactic
lecture/presentation and small group, case-based
learning in a synchronous learning environment.

Sophomores: The primary delivery modality for sophomore dental
students is via the laboratory, classroom/didactic
lecture and small group, case-based learning in a
synchronous learning environment.

Juniors: The primary delivery modality for junior dental
students is didactic lecture and clinical observation with a
preceptor in a synchronous learning environment.

Seniors: The primary delivery modality for senior dental
students will be direct patient contact in the dental
clinics with a faculty observer and didactic lecture in a
synchronous learning environment.


Instructional Strategies:

Freshmen dental students will be instructed via:

Defining critical thinking.

Exercises from the American Dental Association on How to Apply Critical Thinking

Understand the Elements of Thought.

Learning the kinds of questions with which critical thinkers need to be familiar.

How to question a concept, data, information and experience leading to an integrated, complex,
interdisciplinary understanding.

How to interrelate biochemistry and dental occlusion Elements of Thought informs this process.

Evaluation will occur through case-based exercises that have basic science components. Students will be
required to interpret cases based on the principles of critical thinking discussed in reading assignments,
handouts, and lectures using The Art of Asking Essential Questions as the paradigm. There will be case-
based multiple choice examinations where students will have to apply principles of critical thinking. Evaluative
feedback will be provided via a grading rubrics in addition to face-to-face interaction with faculty to review
course assignments and examinations and any necessary remediation. Remediation will occur for those
students failing to perform at an acceptable level. They will be required to consult with an educational skills
specialist in one-on-one or small group sessions to develop an understanding of course materials.



Sophomore dental students will be instructed via:

Applying critical thinking to pre-clinical courses.

Pre-Clinical faculty will work with an educational skills specialist to identify pre-clinical and dental laboratory
exercises from the American Dental Association.

In small groups, sophomore dental students will be able to develop logical explanations of the case using pre-
clinical knowledge and critical thinking skills.

Through individual exercises, each student will be given a pre-clinical case . Students will be expected to apply
pre-clinical knowledge and critical thinking skills.

Evaluation will occur through the students successful negotiate computer-based multiple-choice examination
that integrates pre-clinical and critical thinking knowledge.

Evaluative feedback will be provided through a rubrics for team and individual assignments/cases and verbal
consultation with skills specialist and faculty member. Remediation will occur for those students failing to
perform at an acceptable level. They will be required to consult with an educational skills specialist in one-on-
one or small group sessions to develop an understanding of course materials.



Junior dental students will be instructed via:

Introduction to clinical knowledge. Students have the opportunity to observe the dentist/patient interaction that
includes diagnosis, treatment plan and bedside manner.

Introduction to dental procedures which will require critical thinking skills for understanding the appropriate
procedures to use in patient care.

Using The Thinkers Guide to Clinical Reasoning, junior dental students will complete small group and
individual exercises. They will self-assess their critical thinking skills and be evaluated by a clinical preceptor.

Evaluation will occur on three levels, the preceptor will use the Socratic Method in questioning students
understanding of clinical observations. The student will self assess using a template of questions they would
need to address regarding whether they understand what occurs in the dental clinics with the dentist/patient
interaction and discuss with preceptor. Finally, students will complete a computer-based examination consisting
of cases and appropriate radiographs and data needed to make sound clinical decisions.

Students will receive feedback from clinical faculty meeting one-on-one in skills consultation. Remediation will
occur for those students failing to perform at an acceptable level. They will be required to consult with an
educational skills specialist in one-on-one or small group sessions to develop an understanding of course
materials.

Instructional Plan Template | Slide 13

Senior dental students will be instructed via:

Direct patient interaction under the supervision of clinical faculty.

Integration of clinical knowledge and critical thinking skills based on Blooms Taxonomy to analyze, evaluate and
create knowledge.

Evaluation will occur through self-assessment of the patient interaction; peer assessment in groups reviewing
patient case from clinical and critical thinking perspective regarding patient management.

One-on-one sessions with clinical faculty for assessment of patient management plan and how the student
integrated critical thinking skills with clinical knowledge for patient care.

Review of patient care decisions and strategies to be employed based on those decisions for patient management.

Evaluation of student performance on case-based examinations in line with the NBDE Part I conceptual framework
and format.

Feedback is provided through one-on-one sessions with clinical faculty. The students ability to analyze, evaluate
and synthesize basic science and clinical knowledge and apply critical thinking skills to patient management.
Remediation will occur for those students failing to perform at an acceptable level. They will be required to consult
with an educational skills specialist in one-on-one or small group sessions to develop an understanding of course
materials.


Plan for Implementation:
Timeline for each classification of students: Required three credit hour, six-week module. Class meets synchronously two days per
week for two hours each session. The syllabus will communicate the instructional plan. Interest will be cultivated via the CODA
competency requirement and the mandatory nature of the course.

Freshman:
Basic science faculty, Educational Skills Specialist, Academic Computing Staff
Basic Science text books, Computer, Handouts/Presentations, ADA Case-Based Exercises, The Art of Asking Essential Questions,
Classroom/Lecture Hall, Whiteboard, A/V Equipment Hardware/Software, Blackboard
Syllabus will communicate instructional plan
Required Course

Sophomore:
Pre-clinical faculty, Educational Skills Specialist, Academic Computing Staff
Pre-clinical (lab) Text books, Computer, Handouts/Presentations, ADA Case-Based Exercises, The Art of Asking Essential Questions
Classroom/Lecture Hall, Laboratory, Whiteboard, A/V Equipment Hardware/Software, Blackboard
Required Course
Junior:
Clinical science faculty, Educational Skills Specialist, Academic Computing Staff, Preceptor
Clinical text books, Computer, Handouts/Presentations, ADA Case-Based Exercises, Clinical Reasoning, Blackboard
Laboratory, Classroom/Lecture Hall, Dental Clinics, Whiteboard, A/V Equipment Hardware/Software
Required Course
Senior:
Clinical science faculty, Educational Skills Specialist, Academic Computing Staff
Clinical text books, Computer, Handouts/Presentations, ADA Case-Based Exercises, Clinical Reasoning, Blackboard
Dental Clinics, Classroom/Lecture Hall, Whiteboard, A/V Equipment Hardware/Software
Required Course

* Based on CODA competency requirements.


Instructional Resources:
Freshmen: Classroom, white boards, audio visual/presentation hardware and
software, computer, text books, The Thinkers Guide to The Art of Asking
Essential Questions, The International Critical Thinking Reading &
Writing Test and American Dental Association Case-Based Exercises,
Blackboard.

Sophomores: Classroom, white boards, audio visual/presentation hardware and
software, computer, gross anatomy laboratory, text books, The Thinkers Guide
to the Art of Asking Essential Questions and American Dental Association Case-
Based Exercises, Blackboard.

Juniors: Gross anatomy laboratory, dental simulation center, clinics, classroom, white
boards, audio visual/presentation hardware and software, text books, The
Thinkers Guide to Clinical Reasoning and American Dental Association Case-
Based Exercises, Blackboard.

Seniors: Dental clinics, classroom, white boards audio visual/presentation hardware
and software, The Thinkers Guide to Clinical Reasoning and American Dental
Association Clinical Case-Based Exercises, Blackboard.

Formative Assessment:
Five Formative Assessment Strategies that may be incorporated into the
implementation of critical thinking in the health professions curriculum for
dentistry are:

Definitions Are Us Prompts students to answer a question targeting the big idea of the lesson.

Is That A Fact? Prompts students to examine the difference between factual statements and an
opinion-based statement.

Directed Paraphrasing Builds personal definitions or explanations of concepts presented in class.

Facts/Questions/Responses Examines a piece of text in terms on identifying factual information,
eliciting questions, and generating personal reactions.

How Do I Know What I Know? - Uses tightly focused question sets to determine a students level
of understanding about key ideas or concepts.


Evaluation Strategies:
Without an effective plan for student learning, poor performance on achievement of learning
outcomes results.

There would be three levels of evaluation for the pre-clinical years (freshman and sophomore),
involving the learner, the instructor and the educational skills specialist. The students will provide
constructive feedback as to the organization, execution of the instruction and the extent to which
their learning needs were met. The students will provide this feedback via survey employing open
ended and five-point likert-scale questions, which will provide quantitative and qualitative data for
analysis. Students must also complete an exit interview with an educational skills specialist.
The skills specialist will, in turn, provide a recommendation to the faculty based on the learner exit
interview.

Faculty evaluate student performance via objective examinations, (quizzes, departmental
examinations, laboratory work and competency examination, which indicates readiness for the
NBDE Part I.) and to determine if learning objectives were met. Students must demonstrate 85%
proficiency on a case-based competency examination requiring critical thinking, basic and pre-
clinical science integration and sound pre-clinical reasoning before sitting for the NBDE Part I
licensure examination.

The student, faculty and educational skills specialist evaluations and recommendations
complement one another. The results of which will be used to augment future course offerings.

There would be three or more levels of evaluation for the clinical years (junior and senior), involving the
learner, the faculty/preceptor, the educational skills specialist and the patient.

The students will provide constructive feedback as to the organization, execution of the instruction and
the extent to which their learning needs were met. The students will provide this feedback via survey
employing open ended and five-point likert-scale questions and provide qualitative and quantitative data
for analysis. The student is also required to participate in an exit interview with an educational skills
specialist. Based on this exit interview, the educational skills specialist will provide feedback to the
faculty/preceptor regarding the students mastery of the learning objectives.

For Junior level students, the faculty/preceptor will assess student learning and evaluate each students
ability to create, synthesize, evaluate, analyze, apply, understand and remember clinical knowledge and
make patient care decisions based on sound clinical reasoning. The faculty/preceptor will determine to
what extent the learner has integrated basic and pre-clinical sciences, mastered the learning objectives
and can apply all levels of critical thinking to the clinical sciences. This evaluation will occur via observation
of student performance in the laboratory, with simulated dental patients to determine the learners ability to
apply all levels of critical thinking to the observation of patient care and their course work. Students will be
evaluated via objective examination, (quizzes and departmental examinations).


For senior level students with direct patient contact, the clinical faculty will evaluate each students ability to create,
synthesize, evaluate, analyze, apply, understand and remember clinical knowledge and make patient care decisions based on
sound clinical reasoning. She will determine to what extent the learner has mastered the learning objectives and can apply all
levels of critical thinking to direct patient care. This evaluation will occur via observation of student performance with dental
patients and the learners ability to apply all levels of critical thinking to make patient care decisions based on sound clinical
reasoning. Evaluation will also occur via objective examinations, (departmental examinations and competency examination,
which indicates readiness for the NBDE Part II licensure examination.)

Students must demonstrate 85% proficiency on a case-based competency examination requiring integration of basic and
clinical sciences, critical thinking and sound clinical reasoning before sitting for the NBDE Part II licensure examination. This
helps faculty to assess a students level of competency with patient management before the student graduates into the
profession.

The students will evaluate the faculty, course content, learning exercises and extent to which their learning needs were met.
Additionally, senior level students will also complete the American Association of Medical Schools (AAMC) Graduating
Student Questionnaire providing feedback on their entire health professions educational experience. The questionnaire
instrument will employ a five- point likert scale providing both qualitative and quantitative data for analysis.

Finally, the patient will be asked to complete a survey employing a likert-scale to determine their level of satisfaction with the
dental care provided. The survey instrument will also include several open-ended questions providing the opportunity for
comment and provide qualitative and quantitative data for analysis.

All survey results, evaluations and recommendations complement one another. The results of which will be used to improve
the curriculum for students who will follow.

Outcome Review:
The instructional plan outcome review will be comprised of the results of
various student performance measures, including:

Case-based ADA exercises, course work and examination scores
Grading rubrics will be developed to provide structure and evaluate exercises and course work. The following
grading scale will be employed to evaluate student performance:
A = 90-100
B= 80-89
C= 70-79
F= 69 and below

Clinical Competency
Faculty employ a checklist to evaluate student performance in the simulation laboratory. Faculty will employ a
checklist to evaluate students clinical competency in the dental clinics with patient management.

Competency examination scores
100 percent of dental students must pass the competency examination with 85% proficiency before being allowed to
sit for licensure examination.

Pass rate on NBDE Parts I and II
The dental schools seeks a 90% first-time-taker pass rate on dental licensure examinations.


Recommendations:
As the Commission on Dental Accreditation (CODA) requires all dental graduates to be competent in
the use of critical thinking and problem-solving, including their use in the comprehensive care of
patients, scientific inquiry and research methodology, I recommend the following:

Increase critical thinking course clock hours to those recommended in this instructional plan.

Increase patient contact hours for junior and senior level students so they will have more time to
perfect the integration of basic and clinical sciences, critical thinking and sound clinical reasoning.

Provide financial incentives augment patient recruitment for senior level students. (Senior level
students are required to recruit some of their own patients to demonstrate mastery of certain
complex dental procedures required for graduation) .

Develop an additional dental residency program in order to retain our dental graduates and
potentially recruit them as teaching faculty. (Currently, there are general practice and oral
maxillofacial residency programs. A pediatric dentistry residency program could provide an additional
revenue stream in addition to enhancing the institutions specialized training program offerings.)

References:
American Association of Medical Colleges (AAMC) 2012 Medical School Graduation Questionnaire:
https://www.aamc.org/download/277728/data/2012survey.pdf

Bloom's Taxonomy. (n.d.). Retrieved from http://ww2.odu.edu/educ/roverbau/Bloom/blooms_taxonomy.htm

on November 19, 2012.

Brown, A., Green, T. (2006). Essentials of Instructional Design: Connecting Fundamental Principles with Process and

Practice, 1 e. Prentice Hall, Inc., pp. 4.

Commission on Dental Accreditation. (2012). Standards for Dental Education Programs. Retrieved from
http://www.ada.org/sections/educationAndCareers/pdfs/current_predoc.pdf .

Chen, C. K., (2012). Meharry Medical College United State Department of Education Historically Black Graduate

Institution Part B Grant Application, pp. 10.


References:
Elder, L., & Paul, R. (2010). The Thinker's Guide to The Art of Asking Essential Questions (5th ed.). Dillon Beach,
California: The Foundation for Critical Thinking Press.
Formative Assessments. (2006). Tennessee Department of Education. Resources for STEM Teachers. Retrieved from
http://www.stemresources.com/index.php?option=com_content&view=article&id=52&Itemid=70 on November
25, 2012.
The Foundation for Critical Thinking, (1987). The Critical Thinking Community. Defining Critical Thinking. Retrieved
from http://www.criticalthinking.org/pages/defining-critical-thinking/766 on November 25, 2012.
Hawkins, D., Elder, L., and Paul, R., (2010). The Thinkers Guide to Clinical Reasoning, The Foundation for Critical
Thinking Press. Dillon Beach, California.
Heinich, R., Molenda, M., Russell, J., & Smaldino, S., (2002). Instructional media and technologies for learning (7
th
ed.). Upper
Saddle River, NJ: Merrill/Prentice Hall.

Osborn, C., & Batz, J. (2012). Keep Peace & Learning In a Multi-Generational Workforce. Retrieved from

http://www.bizlibrary.com/AboutUs/WhitePapersandeBooks/TrainingAcrossGenerations.aspx

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Critical Thinking in Dentistry| Slide 1

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